The answer depends on the state. Today, I examine an Urban Institute research paper that looks at this progress in more detail.
Dividing States into 3 Group
The most advance States fall into Group 1 (CA, CO, CT, DC, HI, IN, MA, MD, NV, OR, RI, UT, VT, WA, WV). These states have either enacted an exchange establishment law or in which the governor has established one by issuing an executive order. Massachusetts and Utah had already passed exchange laws before enactment of the ACA. All Group 1 states (except Colorado, Massachusetts and Utah) have received an exchange establishment grant.
Group 2 states (AL, AZ, DE, IA, ID, IL, KY, ME, MI, MN, MO, MS, NC, NE, NJ, NM, NY, PA, TN, VA, WI) have not yet established exchanges, but have demonstrated significant interest in doing so. Most notably, 17 of the 21 states have received level 1 federal establishment grants, which represent a second round of funding for state exchange development work beyond the initial state planning grants. Although Wisconsin has not received a level 1 federal establishment grant, Wisconsin is using federal funds to develop an IT system to fully integrate exchange eligibility determination and enrollment with state-based public insurance programs (i.e., Medicaid and CHIP). Recently, however, Wisconsin Governor Scott Walker has rejected all federal funding for implementation of the ACA. Of the remaining four states, Virginia and Wisconsin have passed legislation stating its intent to develop an exchange, although they have not yet passed exchange establishment legislation, New Jersey has establishment legislation pending in its legislature, and Pennsylvania’s governor has recently announced that his administration is taking steps to establish a state exchange.
Group 3 states (AK, AR, FL, GA, KA, LA, MT, ND, NH, OH, OK, SC, SD, TX, WY) do not meet any of the criteria for Groups 1 and 2 and are the furthest from successfully implementing the ACA provisions.
Correlation between Exchange Progress and Potential Increases in State Health Insurance Coverage
A research article from the Urban Institute finds that States with the ‘most to gain’ from the ACA are actually the most likely to fall into Group 3. States that currently have the least generous Medicaid programs and the largest share of uninsured workers are the least likely to have made significant progress in implementing the ACA provisions.
I can think of two reasons for this finding. The first is philosophical. These States began with less generous health insurance programs. Thus, the residents (or politicians) in these States may prefer to have less generous health insurance programs than other States. Hence the natural aversion to implementing the ACA provisions. The second reason is financial. Because these States have the largest share of uninsured individuals, they would also incur the largest percentage increase in cost to finance the ACA provisions. Although it is true that these States would likely receive the largest subsidies, these subsidies will not cover the full cost of the ACA implementation.
Questions States need to answer to implement an Exchanges
- Should the exchange be run by an existing government agency, a new agency, a quasi-governmental entity or a not-for-profit private entity?
- What should the composition of the governing board be?
- How should the administrative costs of running an exchange be financed?
- Should the exchange be able to actively negotiate with plans over premiums?
- Can plans be excluded, or must all qualified plans be allowed to participate?
- In computing premiums, should enrollees in the Small Business Health Options Program (SHOP) exchange and nongroup exchange markets be pooled together, or should their premiums be set separately?
- What will be the role of agents and brokers in the exchange?
- Should state insurance regulations be identical inside and outside the exchange?
- How will Medicaid/CHIP eligibility and enrollment be integrated with the exchange?
- Should the Basic Health Plan option be implemented?
Source: Blavin F, Buettgens M and Roth J “State Progress Toward Health Reform Implementation: Slower Moving States Have Much to Gain.” RWJF and Urban Institute Real Time Policy Analysis, January 2012.
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Sign in now[...] 1. Engage individuals in their health throughout their life, during life transitions and propose recommendations centered on micro-segments. This approach would automatically group individuals of like-inclinations and make health products and services recommendations that extend beyond simply dealing with health care services based on episodes of illness. [...]
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While ACOs aren’t perfect. The idea is a step in the right direction.
I agree that the burden from cost of malpractice, especially from
Need for defensive medicine will urgently needs to be addressed.
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we moved forward.
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I believe the correct code for Kansas is KS.
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This does not appear to follow from the thrust of the story narrative. Should it read “…concluded that Dr. Potti was NOT right.” or something like that?
Not quite, Jason. The house voting to repeal something still means it must pass the Senate and receive the President’s signature.
The ABC article you linked to says as much: “Boehner called on the Senate to ‘follow the House’s lead, scrap the law, and work with us to enact reforms that will actually lower health care costs without hurting small businesses and jeopardizing coverage for families.’”
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FDR made the depression worst and extended it another decade. Obama is doing the same thing.
Actually the employment status of physicians and other health care providers who treat patients with unfunded costs is of relatively little consequence.
All health care providers are held accountable for the costs of the care they provide. The real problem is that health care providers across the board try to minimize their exposure to such costs and this can only be accomplished by delaying and denying care to their patients.
So, let’s imagine what happens when a physician is standing across from a patient who needs open heart surgery but came in complaining about the flu. Does the health care provider tell the patient that they need open heart surgery, aggressively treat the patient, and assume the onus of the burden for costs to themselves or their facility? Or, does the health care provider mention that the flu seems to be going around, write out a prescription for common antivirals, and other symptomatic relief?
If the health care provider aggressively treats the costs may be in the tens of thousands of dollars and you better believe these costs will be noted and critiqued by professional peers and finance and accounting personnel. These costs will influence monthly, quarterly, annual, and lifetime cost reports for the deemed responsible provider and will also affect retention, promotions, and partnership decisions.
Providers that repeatedly aggressively treat patients without the ability to pay suffer greatly.
Eventually such providers learn what others already accepted, if the health care provider blows the patients off the costs are nil.
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The moment when you most need your health care benefits is not necessarily going to have been the moment you expected to need them. God laughs as much about our sense of predictability as he does about our life plans.
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